Oral Posters: Thoraco-lumbar Degenerative

Presented by: G. Poorman - View Audio/Video Presentation (Members Only)

Author(s):

J.F. Baker(1), S. McClelland, III(2), B.G. Line(3), J.S. Smith(4), H. Gold(5), R.A. Hart(6), C.P. Ames(7), S. Bess(3)

(1) Auckland City Hospital, Department of Orthopaedic Surgery, Auckland, New Zealand
(2) Hospital for Joint Diseases at NYU Langone Medical Center, Department of Orthopaedic Surgery, New York, NY, United States
(3) Denver International Spine Center, Denver, CO, United States
(4) University of Virginia Medical Center, Department of Neurological Surgery, Charlottesville, VA, United States
(5) NYU School of Medicine, Department of Population Health, New York, NY, United States
(6) Swedish Neuroscience Institute, Department of Neurosurgery, Seattle, WA, United States
(7) University of California, San Francisco Medical Center, Department of Neurological Surgery, San Francisco, CA, United States

Abstract

Background: Surgical treatment of spinal pathology in patients with Parkinson's disease (PD) has the potential for increased complication risk and increased failure compared to the normal population. There remains a dearth of published information regarding the outcomes following lumbar spine surgery in PD patients with existing research focusing on construct failures and long term results.

Purpose: The aim of this study was to determine whether or not the presence of PD conferred an increased risk of immediate and in-hospital complication following elective lumbar spine surgery.

Study Design/Setting: Retrospective cohort study

Patient Sample: The Nationwide Inpatient Sample from 2001-2012 was used for analysis; this database comprises approximately 20% of all nonfederal hospital inpatient admissions and discharges in the United States.

Outcome Measures: 42 postoperative variables, including total hospital charge greater than $200,000, routine discharge disposition, length of stay > one week, in-hospital mortality, durotomy, paraplegia, infection, venous thrombotic events, inferior vena cava placement, and pulmonary embolism were analyzed to assess the impact of PD on each variable.

Methods: Admissions having a diagnosis code consistent of lumbar spine pathology (ICD-9 codes = 22.10, 722.73, 722.93, 722.52, 724.02, 724.03, 722.52, 724.3, 738.4, 721.3, 721.42) and primary procedure codes corresponding with fusion or decompression (ICD-9 codes = 81.06, 81.07, 81.08, 81.00, 3.09) were included, and then stratified based on the presence or absence of Parkinson's disease (ICD-9 code = 332.0); to minimize confounding variables patients with cancer (ICD-9 codes = 140.0-239.0) or trauma (ICD-9 codes = 805.0-806.9) were excluded. Propensity Score Matching (PSM) of a randomly chosen representative subset was used to adjust the analysis for several variables including patient age, race, sex, and primary payer for care.

Results: 613,522 lumbar spine surgery patient episodes were identified, of which 4,492 (0.7%) had a diagnosis of PD. PSM of a 15,000 patient subset (all 4,492 PD; 10,508 non-PD) revealed that patients with PD had significantly less postoperative complications including durotomy, paraplegia, hematoma/seroma, pulmonary embolism, postoperative shock, venous thromboembolism, and ARDS (all P< .001). Additionally those with PD had a lower incidence of prolonger hospital stay (> 1 week), total hospital charge > $200,000, and inhospital mortality (all P< .001). There were no complications (cardiac, pulmonary, neurologic included) more frequently encountered in those with PD than those without.

Conclusions: Findings from a nationwide database analysis over a 12-year period suggest that immediate and in-hospital complications are not more frequent in those with PD than those without. This is likely multifactorial and may reflect selection bias of 'healthier' patients with PD or reflect the weakness of large database analyses (e.g. inability to establish severity of PD). As further outcomes from spinal surgery in those with PD are reported, attention to the immediate and in-hospital medical outcomes should also be reported.